Term
amenorrhea can be caused by excess of what hormone?
what disease normally causes this? |
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Definition
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Term
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Definition
| eight gain, vaginal dryness, inferrtility, decreased libido |
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Term
| amenorrhea caused by hypothalmus can be caused by? -3 |
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Definition
weight loss
exercise (low body fat)
functional problem |
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Term
| amerorhea caused by the ovary- 2 |
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Definition
genetic (no follicles)
-premature failure |
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Term
| amenorrhea caused by uterus- 2 |
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Definition
postsurgical adhesion
congenital abnormality |
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Term
what can cause decreased clearence of prolactin?
this causes? |
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Definition
decresased renal/hepatic clearence
amenorhea |
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Term
| most important thing for diagnostic workup of amenorrhea |
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Definition
| identifying the underlying cause |
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Term
general labs done for amenorrhea- 3
labs done if suspect ovarian failure? -2
labs done if suspect PCOS?-3 |
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Definition
preggo test, TSH, prolactin
-LH,FSH
-testosterone, progestoerone, lipids |
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Term
| treatment goals of amenorrhea -2 |
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Definition
preserve bone density
improve fertility |
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Term
if amenorrhea is caused by weight loss (eating disorder/excess excercise) what is the first treatment?
if this doesnt work? |
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Definition
increase weight/ decrease exercise
estrogen |
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Term
| if amenorrhea is caused by hyperprolactinemia what is the treatment |
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Definition
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Term
| if amenorrhea is caused by PCOS anovulation what is treatment? -2 options |
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Definition
if preggo wanted-clomiphene citrate/ insulin sensitizing
if preggo not wanted-insulin sensitizing + OC w/ progesterone |
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Term
| if cause of amenorrhea is unknown what is treatment? |
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Definition
| progestin + esgtrogen/progestin therapy |
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Term
| why do you give estrogen to amenorrhea person |
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Definition
| osteoporosis risk- it increases Ca |
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Term
| progesterone is given to woman with amenorrhea because |
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Definition
| protects uterus against hyperlasia/cancer |
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Term
| what secretions do combo OCs suppress? -2 |
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Definition
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Term
| ADEs of combo oral contracpetives-4 |
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Definition
| weigh gain, GI, breast change, headache |
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Term
| drug interactions with combo OCs -3 |
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Definition
st. john's wort
rifampin
sulfa |
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Term
| if have increased level of prolactin causing amenorrhea but they DONT want to get preggo what therapy do you use? |
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Definition
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Term
| which dopamine agonist do you take with food? |
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Definition
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Term
| what is the dosing scheduling for bromocriptine |
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Definition
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Term
| what is the dosing schedule for cabergoline |
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Definition
| .5 mg qwk; then 1-2 mg 2x/wk |
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Term
| how long does it take to see effects of dopamine agonists? |
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Definition
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Term
Side effects of dopamine agonists -3
what metabolism do the inhibit? |
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Definition
hypotension, N/C, anorexia
CYP3A4 |
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Term
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Definition
| GI, lactic acidosis, flatulence |
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Term
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Definition
| weight gain, lipids, headache |
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Term
| goals of menorrhagia therapy-2 |
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Definition
reduce blood loss
delay/prevent surgery |
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Term
| what is the first question asked to decide therapy for menorrhagia? |
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Definition
| is contraception desired? |
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Term
what is first line treatment for menorrhagia if don't want contraception?
if not effective use? (2 options)
if this not effective use? |
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Definition
NSAIDS -during menses
tranexamic acid or luteal phase progesterone;
IUD, OC, |
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Term
what is first line therapy for menorrhagia if DO want contraception?
if this isnt effectve use? |
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Definition
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Term
when are NSAIDS for menorhaggia used?
MOA? |
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Definition
during menses
reduce PGs, reduce inflammation, reduce blood |
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Term
| why is the IUD first line compared to OC in menorrhagia? -2 |
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Definition
cost effective
less failure |
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Term
| at what dose of estradiol does OC have efficacy in menorrhagia |
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Definition
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Term
| what are the 2 options of progesterone therapy for menorrhagia? |
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Definition
-luteal phase
-21 day starting on 5th day of menses |
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Term
when do patients come back for follow up after meonrrhagia therapy?
what labs do you measure at this time? |
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Definition
1 cycle
hemaotcrit/hemoglobin |
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Term
| if on hromonal therapy for menorrhagia what follow ups need to be done? -3 |
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Definition
annual gyneo
lipids 3-6 mo
BP in 4-6 weeks |
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Term
| most common cause of anovulatory bleeding? |
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Definition
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Term
| symptoms of anovulatory bleeding? -2 |
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Definition
-heavy bleeding
-perimenopausal symtpoms |
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Term
| signs of anovulatory bleeding (specifiaclly PCOS) -3 |
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Definition
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Term
for anovulatory bleeding what labs do you do for:
PCOS: -3
Perimenaupausal: -1 |
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Definition
testosterone, lipds, glucose
FSH |
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Term
| when do you do an endometrial biopsy for anovulatory bleeding? |
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Definition
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Term
short term goal for anovulatory bleeding?
long term goals?-3 |
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Definition
control bleeding;
regular cycle, decrease anovulation complications, imropove QOL |
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Term
| for acute bleeding episodes of anovulatory bleeding what is the therapy used? |
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Definition
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Term
| How does OC prevent recurrent anovulatory bleeding- 2 |
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Definition
provides progestin
-suppress ovarian hormones and androgen |
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Term
| how does OC reduce androgen? |
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Definition
| elevates SHBG- this binds/reduces androgen |
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Term
| what should the estradiol dose be for OC in anovulatory bleeding? |
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Definition
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Term
| how do metformin/TZDs work to imporve aovulatory bleeding?- 2 |
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Definition
increase SHBG (reduces andorgen)
improves glucose tolerance |
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Term
when should follow up be for anovulatory bleeding?
when should bleeding decrease? |
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Definition
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Term
| what do you monitor for PCOS patients with anovulatory bleeding |
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Definition
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Term
| nonpharm treatment for dysmenorrhea-3 |
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Definition
heat patch- 12 hrs/day
exercise
low-fat vegetarian diet |
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Term
| first line therapy for dysmenorrhea |
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Definition
| NSAIDS: naproxen, ibuprofen |
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Term
| what are options for dysmenorrhea besides first line? -2 |
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Definition
Cox 2 slective inhibitors
hormonal contraceptives |
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Term
| when do you do follow up for dysmenorrhea using NSAID |
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Definition
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Term
| if you suppress _, symptoms of PMS/PMDD improve |
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Definition
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Term
| life changes for improving PMS/PMDD |
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Definition
reduce caffine, sugar, sodium
increase exercise
Vit B6
Ca. Carbonate |
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Term
| first line pharm therapy for PMS/PMDD-3 |
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Definition
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Term
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Definition
| hot flash, night sweat, bone loss |
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Term
| SSRIs will have improvement of PMS in how long? |
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Definition
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Term
| who do you give therapy to for endometriosis? |
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Definition
ppl w/ active symtpoms:
pain, infertility |
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Term
pharm treatment for endometriosis is inducing a what state? -2 options
what will this not imporve tho? |
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Definition
pesudopreggo
pseudomenopaus
fertility |
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Term
| fist line therapy for endometrioiss-2 |
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Definition
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Term
for first line therapy of endometriosis-
why is it first line?-3
how long is the trial? |
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Definition
cost effective, efficacy, less side effects
3 mo. |
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Term
| what is progestin know to have a risk of (in endometrioiss med options) |
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Definition
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Term
| side effects of 1st line therapy for endometriosis |
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Definition
| nausea, bloat, bleeding, thrombo |
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Term
what is the GnRH agonist that is admin:
IM
SQ
intranasal |
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Definition
leuprolide
goserelin
nafralin |
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Term
| Side affects of GnRH agonists-3 |
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Definition
| vaginal dryness, insomnia, hot flashes |
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Term
| what is "add back" therapy fro GnRH? |
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Definition
| low dose estrogen + progestin (not OC) to prevent bone loss |
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Term
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Definition
| anovulation, amenorrhea, endometrial atrophy |
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Term
| what does Danazol suppress |
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Definition
| the mid cycle Lh/FSH surge |
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Term
| danazol has what side affect? -4 |
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Definition
| -androgenic: acne, hot flashes, decreases breast, LDL |
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Term
| what two disease states would you not use danazol in? |
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Definition
hyperlipidemia
liver disease |
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Term
| what is the last line therapy of endomentriois |
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Definition
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